MEDICARE: KELLY STOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC 17130	CA

General Provider Information

NPI Number	:	1164970265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY STOCK

Provider Business Mailing Address
First Line	:	50 GUILFORD RD
Second Line	:
City	:	PIEDMONT
State	:	CA
Zip	:	94611-3805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 BROWN AVE
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3902
Country	:	US
Telephone Number	:	510-359-4102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2016
Last Update Date	:	09/17/2016

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Directions to “ KELLY STOCK ” Practice Location

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